Provider Demographics
NPI:1871798926
Name:NICOT, GRACE
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:NICOT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1983 MARCUS AVE
Mailing Address - Street 2:STE C102
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-2006
Mailing Address - Country:US
Mailing Address - Phone:516-876-4100
Mailing Address - Fax:516-876-4101
Practice Address - Street 1:1983 MARCUS AVE
Practice Address - Street 2:STE C102
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-2006
Practice Address - Country:US
Practice Address - Phone:516-876-4100
Practice Address - Fax:516-876-4101
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY463924-1163W00000X
NYF304504-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health